Prescott Animal Hospital (PAH Holdings PC) Annual Report (Arizona Corporation Commission) (2013)

STATE OF ARIZONA
BPetEeP CORPORATION COMMISSION paZUR 82
CORPORATION ANNUAL REPORT
& CERTIFICATE OF DISCLOSURE

DUE ON OR BEFORE 03/29/2013 FILING FEE $45.00

PLEASE READ ALL INSTRUCTIONS. The following information is required by A.R.S. §§10-1622 & 10-11622 for all corporations
organized pursuant to Arizona Revised Statutes, Title 10. The Commission’s authority to prescribe this form is A.R.S. §§10-
121(A) & 10-3121(A). YOUR REPORT MUST BE SUBMITTED ON THIS ORIGINAL FORM. Make changes or corrections where
necessary. Information for the report should reflect the current status of the corporation.

-0871367-5

1. PRESCOTT ANIMAL HOSPITAL COMPANION ANIMAL CENTER, P.C.
1318 IRON SPRINGS RD
PRESCOTT, AZ 86305

Business Phone: (Business phone is optional.)
State of Domicile: ARIZONA Type of Corporation: PROFESSIONAL
2. Statutory Agent: MICHAEL L RUBIN Statutory Agent's Street or Physical Address:
Mailing Address: 230 ANDERSON RD Physical Address:
City, State, Zip: PRESCOTT, AZ 85303 City, State, Zip: AZ

ACC USE ONLY

Fee $ 4500
Penalty $ 0.00
Reinstates_ O.00

| do hereby consent to this appointment until my removal or resignation pursuant to law.

Expedite $

Resubmit$ Signature of new Statutory Agent

Printed Name of new Statutory Agent

3. Secondary Address:
(Foreign Corporations are REQUIRED
to complete this section).

4. CHARACTER OF BUSINESS

VETERINARY MEDICINE/ANIMAL CARE

Received: 03/06/2013 12:13

AR:0046 Arizona Corporation Commission
Rev. 12/2008 Corporations Division

-0871367-5 PRESCOTT ANIMAL HOSPITAL COMPANION ANIMAL CENTER, P.C. Page2
5. CAPITALIZATION: (For-profit Corporations and Business Trusts are REQUIRED to complete this section.)

Business trusts must indicate the number of transferable certificates held by trustees evidencing their beneficial interest in the trust
estate.

5a. Please examine the corporation’s original Articles of Incorporation for the amount of shares authorized.
Number of Shares/Certificates Authorized Class Series Within Class (if any)

100000 COMMON

5b. Review all corporation amendments to determine if the original number of shares has changed. Examine the corporation’s
minutes for the number of shares issued.

Number of Shares/Certificates Issued Class Series Within Class (if any)
2000 COMMON

6. SHAREHOLDERS: (For-profit Corporations and Business Trusts are REQUIRED to complete this section.)

List shareholders holding more than 20% of any class of shares issued by the corporation, or having more than a 20% beneficial
interest in the corporation.

DR STEVEN H DOW DR BRYAN K NOLTE
7. OFFICERS
Name: DR STEVEN H DOW Name: JANETH DOW
Title: PRESIDENT Title: SECRETARY
Address: 3075 JENNY DR Address: 3075 JENNY DR
PRESCOTT, AZ 86305 PRESCOTT, AZ 86305
Date Taking Office: 03/29/1999 Date Taking Office: 03/29/1999
Name: DR KENNETH C SKINNER Name: DR MARK E ANDERSON
Title: VICE-PRESIDENT Title: VICE-PRESIDENT
Address: 783 PEPPERMINT WAY Address: 2715 GREEN BRIER
PRESCOTT, AZ 86305 PRESCOTT, AZ 86305
Date Taking Office: 01/01/2009 Date Taking Office: 01/01/2009
8. DIRECTORS
Name: DR STEVEN H DOW Name:
Address: 3075 JENNY DR Address:
PRESCOTT, AZ 86305 Date Taking Office:

Date Taking Office: 03/29/1999

Name: Name:
Address: Address:
Date Taking Office: Date Taking Office:
AR:0046 Arizona Corporation Commission
Rev. 12/2008

Corporations Division

-0871367-5 PRESCOTT ANIMAL HOSPITAL COMPANION ANIMAL CENTER, P.C. Page 3

9. FINANCIAL DISCLOSURE (A.R.S. §10-11622(A)(9))

Nonprofits — if your annual report is due on or before September 25, 2008, you must attach a financial statement (e.g. income/expense statement,
balance sheet including assets, liabilities). If your nonprofit annual report is due after September 25, 2008, a financial statement is not required.
Cooperative marketing associations must in all cases submit a financial statement. All other forms of corporations are exempt from filing a
financial statement no matter what date the annual report was due.

ONLY NONPROFIT CORPORATIONS MUST ANSWER THIS QUESTION:
9A. MEMBERS (A.R.S. §10-11622(A)(6)) This corporation DOES O DOES NOT U have members.

10. CERTIFICATE OF DISCLOSURE (A.R.S. §§ 10-202(D), 10-3202(D), 10-1622(A)(8) & 10-11622(A)(7))

A. — Has any person who is currently an officer, director, trustee, incorporator, or who, in a For-profit corporation, controls or holds more than
10% of the issued and outstanding common shares or 10% of any other proprietary, beneficial or membership interest in the corporation
been:

1. Convicted of a felony involving a transaction in securities, consumer fraud or antitrust in any state or federal jurisdiction within the seven year
period immediately preceding the execution of this certificate?
2. Convicted of a felony, the essential elements of which consisted of fraud, misrepresentation, theft by false pretenses or restraint of trade or
monopoly in any state or federal jurisdiction within the seven year period immediately preceding execution of this certificate?
3. Subject to an injunction, judgment, decree or permanent order of any state or federal court entered within the seven year period immediately
preceding execution of this certificate where such injunction, judgment, decree or permanent order involved the violation of:
(a) fraud or registration provisions of the securities laws of that jurisdiction, or
(b) the consumer fraud laws of that jurisdiction, or
(c) the antitrust or restraint of trade laws of that jurisdiction?

One box must be marked: YESU NOjd

If "YES" to A, the following information must be submitted as an attachment to this report for each person subject to one or more of the
actions stated in Items 1 through 3 above.

1. Full birth name. 5; Date and location of birth.

2. Full present name and prior names used. 6. The nature and description of each conviction or judicial

3. Present home address. action; the date and location; the court and public agency

4. All prior addresses for immediately preceding 7 year involved; and the file or cause number of the case.
period.

B. Has any person who is currently an officer, director, trustee, incorporator, or who, in a For-profit corporation, controls or holds over 20% of
the issued and outstanding common shares, or 20% of any other proprietary, beneficial or membership interest in the corporation, served
in any such capacity or held a 20% interest in any other corporation on the bankruptcy or receivership of that other corporation?

One box must be marked: YESU NOX)

If “YES” to B, the following information must be submitted as an attachment to this report for each corporation subject to the
statement above.

(a) Name and address of each corporation and the persons involved.

(b) State(s) in which it: (i) was incorporated and (ii) transacted business.

(c) Dates of corporate operation.
11. STATEMENT OF BANKRUPTCY OR RECEIVERSHIP (A.R.S. §§ 10-1623 & 10-11623)

A. — Has the corporation filed a petition for bankruptcy or appointed a receiver? One box must be marked: YESQ NO@
If “Yes” to A, the following information must be submitted as an attachment to this report:

1. All officers, directors, trustees and major stockholders of the corporation within one year of filing the petition for bankruptcy or the
appointment of a receiver. If a major stockholder is a corporation, the statement shall list the current president, chairman of the
board of directors and major stockholders of such corporate stockholder. “Major stockholder” means a shareholder possessing or
controlling twenty per cent of the issued and outstanding shares or twenty per cent of any proprietary, beneficial or membership
interest in the corporation.

2. Whether any such person has been an officer, director, trustee or major stockholder of any other corporation within one year of the
bankruptcy or receivership of the other corporation. If so, for each such corporation give:
(a) Name and address of each corporation;
(b) States in which it: (i) was incorporated and (ii) transacted business.
(c) Dates of operation.

12. SIGNATURES: Annual Reports must be signed and dated by at least one duly authorized officer or they will be rejected.

I declare, under penalty of perjury, that all corporate income tax returns required by Title 43 of the Arizona Revised Statutes have been
filed with the Arizona Department of Revenue. | further declare under penalty of perjury that | (we) have examined this report and the
certificate, including any attachments, and to the best of my (our) knowledge and belief they are true, correct and complete.

Signature_pR STEVEN H DOW
Title PRESIDENT

(Signator(s) must be duly authorized corporate officer(s) listed in section 7 of this report.)

AR:0046 Arizona Corporation Commission
Rev. 12/2008 Corporations Division

-0871367-5 PRESCOTT ANIMAL HOSPITAL COMPANION ANIMAL CENTER, P.C.
Additional Officers

Name: DR BRYAN K NOLTE
Title: VICE-PRESIDENT
Address: 7685 N DEERFIELD DR
PRESCOTT, AZ 86305
Date Taking Office: 01/01/2003